İki aylık bir dönemde pediatrik poliklinik hastalarının idrar örneklerinden izole edilen GSBL oluşturan Escherichia coli ve Klebsiella suşları.


Öksüz L. , Gürler N., Akıncı N., Şirin A.

Acta Physiologica Scandinavica, vol.22, no.1, pp.14-19, 2008 (National Refreed University Journal)

  • Publication Type: Article / Article
  • Volume: 22 Issue: 1
  • Publication Date: 2008
  • Title of Journal : Acta Physiologica Scandinavica
  • Page Numbers: pp.14-19

Abstract

Extended-spectrum Beta-lactamase-producing Escherichia coli and Klebsiella Strains Isolated from Urine Samples
of Pediatric Outpatients in a Two-months Period
In this study extended-spectrum beta-lactamase-producing Escherichia coli (n=11) and Klebsiella (n=4) strains isolated from
urine samples of child outpatients in a two-months period in Istanbul Medical Faculty Pediatric Nefrology Department were examined.
All strains showed extended-spectrum beta-lactamase phenotype with E-test ESBL and were susceptible to carbapenems. According
to polimerase chain reaction (PCR) results, nine of the E.coli strains (82 %) were found to produce TEM-type, two strains (18 %)
CTX-M-type beta-lactamases. K.pneumoniae strains (n=2) were found to produce both TEM-type and SHV-type beta-lactamases.
Only one of the K.oxytoca strains (n=2) was found to produce TEM-type beta-lactamase. It was thought that the second K.oxytoca
strain had beta-lactamase other than TEM, SHV; CTX-M beta-lactamases. The profiles generated with RAPD-PCR using ERIC-2
primer contained several bands, ranging in size from 170 to 1500 bp. According to RAPD-PCR assays, it was found that two K.pneumoniae
and two K.oxytoca strains had same profile. In conjugation experiments, 10 of 15 strains (67 %) transferred their resistance
to recipient E.coli strain. Plasmid profile analysis showed that all strains had more than one plasmid. It was found that the sizes of
plasmids were bigger than 48 kb. Although the isolation of many ESBL producing strains in a short period and the similarity of the
strains’ enzyms according to the RAPD-PCR and plasmid analysis results suggested that there may be a relationship between the
strains, a definite relation between the patients was not found. However the clinical diagnosis of many of the patients was disfunction
of bladder. So the disfunction of bladder could be thought as a risk factor for colonization with ESBL-producing bacteria.
Bu çal›flmada, iki ayl›k bir sürede ‹stanbul T›p Fakültesi Pediatrik Nefroloji Bilim Dal›’nda ayaktan takip edilen çocuk hastalar›
n idrar örneklerinden izole edilen genifllemifl spektrumlu beta-laktamaz (GSBL) oluflturan Esherichia coli (n=11) ve Klebsiella
spp. (n=4) sufllar› incelenmifltir. Tüm sufllar karbapenemlere duyarl› bulunmufl ve “E-test ESBL” ile GSBL fenotipi gösterilmifltir.
Polimeraz zincir reaksiyonu (PCR) sonuçlar›na göre, E.coli sufllar›n›n dokuzunun (% 82) TEM-tipi, ikisinin (% 18) CTX-M-tipi
beta-laktamaz üretti¤i bulunmufltur. K.pneumoniae sufllar›n›n (n=2) hem TEM, hem de SHV-tipi beta-laktamaz üretti¤i, K.oxytoca
sufllar›ndan (n=2) ise sadece birinin TEM tipi beta-laktamaz üretti¤i saptanm›fl, ikinci K.oxytoca suflunun TEM, SHV, CTX-M’den
baflka bir beta-laktamaz tafl›d›¤› anlafl›lm›flt›r. ERIC-2 primeri kullan›larak yap›lan RAPD-PCR ile sufllar›n, büyüklükleri 170-1500 bp
aras›nda de¤iflen çeflitli bantlar içerdi¤i bulunmufltur. RAPD-PCR deneylerine göre iki K.pneumoniae ve iki K.oxytoca suflunun
birbiriyle ayn› profile sahip oldu¤u bulunmufltur. Konjugasyon deneylerinde 15 suflun 10’u (% 67) dirençlerini al›c› E.coli sufluna
aktarm›flt›r. Plazmid profil analizi, tüm sufllar›n birden fazla plazmide sahip oldu¤unu göstermifltir. Sufllardaki plazmidlerin 48
kb’dan büyük oldu¤u bulunmufltur. Sonuç olarak, k›sa bir sürede poliklinik hastalar›ndan çok say›da GSBL pozitif suflun izole edilmesi,
RAPD-PCR ve plazmid analizi sonuçlar›na göre sufllar›n büyük bir k›sm›n›n tafl›d›¤› enzimler bak›m›ndan benzerlik göstermesi,
izole edilen sufllar›n iliflkili olduklar›n› düflündürmekle birlikte, sufllar›n izole edildi¤i hastalar aras›nda bir iliflkiye rastlanmam›
flt›r. Ancak hastalarda mesane disfonksiyonu tan›s›n›n çoklu¤u, mesane disfonksiyonunun GSBL oluflturan bakterilerle kolonizasyon
için bir risk faktörü olabilece¤ini düflündürmüfltür.